Report to the Chairman, Committee on 

Finance, U.S. Senate 

United States General Accounting Office 

GAO

May 2004 ENERGY 

EMPLOYEES 

COMPENSATION 

Even with Needed 

Improvements in Case 

Processing, Program 

Structure May Result 

in Inconsistent Benefit 

Outcomes 

GAO-04-516 
www.gao.gov/cgi-bin/getrpt?GAO-04-516.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Robert E. 

Robertson at (202) 512-7215 or 

robertsonr@gao.gov. 

Highlights of GAO-04-516, a report to 

Chairman, Committee on Finance, U.S. 

Senate 

May 2004

ENERGY EMPLOYEES COMPENSATION

Even with Needed Improvements in Case 

Processing, Program Structure May 

Result in Inconsistent Benefit Outcomes 

During the first 21⁄2 years of the program, ending December 31, 2003, Energy 

had completely processed about 6 percent of the more than 23,000 cases that 

had been filed. Energy had begun processing nearly 35 percent of the cases, 

but processing had not yet begun on nearly 60 percent of the cases. Further, 

insufficient strategic planning and systems limitations complicate the 

assessment of Energy’s achievement of goals related to case processing, as 

well as goals related to program objectives, such as the quality of the 

assistance provided to claimants in filing for state workers’ compensation. 

While Energy got off to a slow start in processing cases, it is now processing 

enough cases that there is a backlog of cases waiting for review by a 

physician panel. Energy has taken some steps intended to reduce this 

backlog, such as reducing the number of physicians needed for some panels. 

Nonetheless, a shortage of qualified physicians continues to constrain the 

agency’s capacity to decide cases more quickly. Consequently, claimants will 

likely continue to experience lengthy delays in receiving the determinations 

they need to file workers’ compensation claims. In the meantime, Energy 

has not kept claimants sufficiently informed about the delays in the 

processing of their claims as well as what claimants can expect as they 

proceed with state workers’ compensation claims. 

GAO estimates that more than half of the cases associated with Energy 

facilities in 9 states that account for more than three-quarters of all Subtitle 

D cases filed are likely to have a willing payer of benefits. Another quarter of 

the cases in these 9 states, while not technically having a willing payer, have 

workers’ compensation coverage provided by an insurer that has stated that 

it will not contest these claims. However, the remaining 20 percent of the 

cases in these 9 states lack willing payers and are likely to be contested. This 

has created concerns about program equity in that many of these cases may 

be less likely to receive compensation. Because of data limitations, these 

percentages provide an order of magnitude estimate of the extent to which 

claimants will have willing payers. These estimates could change as better 

data become available or as circumstances change, such as new contractors 

taking over at individual facilities. The estimates are not a prediction of 

actual benefit outcomes for claimants. 

Various options are available to improve payment outcomes for the cases 

that receive a positive physician panel determination, but lack willing 

payers. While not recommending any particular option, GAO provides a 

framework that includes a range of issues to help the Congress assess 

options if it chooses to change the current program. One of these issues in 

particular—the federal cost implications—should be carefully considered in 

the context of the current and projected federal fiscal environment. 

Subtitle D of the Energy Employees 

Occupational Illness Compensation 

Program Act of 2000 allows the 

Department of Energy (Energy) to 

help its contractors’ employees file 

state workers’ compensation 

claims for illnesses determined by 

a panel of physicians to be caused 

by exposure to toxic substances 

while employed at an Energy 

facility. 

This report examines the 

effectiveness of the benefit 

program under Subtitle D and 

focuses on four key areas: (1) the 

number, status, and characteristics 

of claims filed with Energy; (2) the 

extent to which Energy policies 

and procedures help employees file 

timely claims for these state 

benefits; (3) the extent to which 

there will be a “willing payer” of 

workers’ compensation benefits, 

that is, an insurer that—by order 

from or agreement with Energy—

will not contest these claims; and 

(4) a framework that could be used 

for evaluating possible options for 

changing the program. 

Energy generally agreed with GAO 

recommendations that the agency 

take additional steps to expedite 

the processing of claims through its 

physician panels, enhance its 

communications with claimants, 

improve its case management data 

and its capabilities to aggregate 

these data to address program 

issues, and consider developing a 

legislative proposal to address the 

willing payer issue. 
Page i GAO-04-516 Energy Employees Compensation 

Letter 1

Results in Brief 2

Background 4

Energy Has Processed Few Cases, and Insufficient Strategic 

Planning and Data Collection Complicate Program Management 7

A Shortage of Qualified Physicians to Issue Determinations Delays 

Filing of Workers’ Compensation Claims, and Claimants May 

Receive Inadequate Information to Prepare Them to Pursue 

These Claims 12

While Workers’ Compensation Claims for a Majority of Cases Are 

Not Likely to Be Contested, Actual Compensation Is Not Certain 16

Several Issues Could Be Considered in Evaluating Options for 

Improving the Likelihood of Willing Payers 21

Conclusions 29

Recommendations for Executive Action 30

Agency Comments and Our Evaluation 31

Appendix I Scope and Methodology 33 

Appendix II Comments from the Department of Energy 36 

Appendix III GAO Contacts and Staff Acknowledgments 39 

GAO Contacts 39

Staff Acknowledgments 39

Tables 

Table 1: Extent to Which Cases Will Potentially Be Contested in 9 

States 19

Table 2: Framework for Evaluating Options to Change the Subtitle 

D Program 27

Figures 

Figure 1: Energy’s Claims Process 6

Figure 2: Case status as of December 31, 2003 8

Contents 
Page ii GAO-04-516 Energy Employees Compensation 

Figure 3: Distribution of Cases by Employee’s Last Energy Facility 

Worked 9

Abbreviations 

CMS Case Management System 

EEOICPA Energy Employees Occupational Illness Compensation 

 Program Act 

NIOSH National Institute for Occupational Safety and Health 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 
Page 1 GAO-04-516 Energy Employees Compensation 

May 28, 2004 

The Honorable Charles E. Grassley 

Chairman, Committee on Finance 

United States Senate 

Dear Mr. Chairman: 

For the last several decades, the Department of Energy (Energy) and its 

predecessor agencies and contractors have employed thousands of 

individuals in secret and dangerous work in the nuclear weapons 

production complex. Over the years, employees were exposed to toxic 

substances, including radioactive and hazardous materials, and studies 

have shown that many of these employees subsequently developed serious 

illnesses. The Energy Employees Occupational Illness Compensation 

Program Act (EEOICPA) established two programs to help secure 

compensation for employees who developed occupational illnesses or for 

their survivors. Congressional Committees, as well as individual Members 

of Congress, claimants, and advocates have raised concerns regarding 

Energy’s processing of claims and the availability of benefits once claims 

have been decided. 

Enacted as title XXXVI of the Floyd D. Spence National Defense 

Authorization Act for Fiscal Year 2001, which was signed into law on 

October 30, 2000, this legislation has two major components. Subtitle B 

provides eligible workers who were exposed to radiation or other toxic 

substances and who subsequently developed illnesses, such as cancer and 

lung disease, with a one-time payment of up to $150,000 and covers future 

medical expenses related to the illness. The Department of Labor 

administers these benefits, payable from a compensation fund established 

by the same legislation. Subtitle D allows Energy to help its contractor 

employees file state workers’ compensation claims for illnesses 

determined by a panel of physicians to be caused by exposure to toxic 

substances while employed at an Energy facility. Individuals may apply for 

and receive benefits under both programs since benefits are not offset 

against each other. 

You asked that we study the effectiveness of the benefit program under 

Subtitle D of EEOICPA in assisting employees of Energy’s contractors in 

obtaining compensation for occupational illnesses. In addition, in the 

conference report for the 2003 appropriations for Energy, the conferees 

United States General Accounting Office 

Washington, DC 20548 
Page 2 GAO-04-516 Energy Employees Compensation 

directed that we study this issue (see GAO-04-515). We focused our work 

on four key areas: (1) the number, status, and characteristics of claims 

filed with Energy; (2) the extent to which Energy policies and procedures 

help employees file timely claims for state workers’ compensation 

benefits; (3) the extent to which there will be a “willing payer” of workers’ 

compensation benefits; that is, an insurer that—by order from, or 

agreement with, Energy—will not contest these claims; and (4) a 

framework that could be used for evaluating possible options for changing 

the program to the extent that there may not be willing payers of benefits. 

To perform our review, we analyzed data extracted from Energy’s Subtitle 

D case management system for applications filed through June 30, 2003, 

and again through December 31, 2003. We determined that the data we 

used were sufficiently reliable for our purposes by performing electronic 

testing for obvious errors in accuracy and completeness, reviewing 

available documentation, and interviewing agency officials and 

contractors knowledgeable about the data. We also reviewed the 

provisions of, and interviewed officials with, the workers’ compensation 

programs in 9 states, which account for more than three-quarters of 

Subtitle D cases filed, and we interviewed the contractors operating the 

major facilities in these states. In addition, we conducted site visits to 

three Energy facilities in Oak Ridge, Tennessee, the state with facilities 

accounting for the largest number of Subtitle D claims. We also 

interviewed key program officials and other experts. We conducted our 

review from April 2003 through April 2004 in accordance with generally 

accepted government auditing standards. For a more complete 

explanation of our methodology, see appendix I. 

During the first 21⁄2 years of the program, ending December 31, 2003, 

Energy had fully processed about 6 percent of the more than 23,000 cases 

received. Most of the fully processed cases had been found ineligible 

because of either a lack of employment at an eligible facility or an illness 

related to toxic exposure. Less than 1 percent of all cases had received a 

determination by a physician panel, a document needed to pursue a 

workers’ compensation claim under this program. In addition, Energy had 

not begun processing on nearly 60 percent of the cases it has received. 

Insufficient strategic planning and systems limitations complicate the 

assessment of Energy’s achievement of goals related to case processing, as 

well as goals related to program objectives, such as the quality of the 

assistance provided to claimants in filing for state workers’ compensation. 

Results in Brief 
Page 3 GAO-04-516 Energy Employees Compensation 

While Energy got off to a slow start in processing cases, it is now 

processing enough cases that there is a backlog of cases waiting for review 

by a physician panel. Energy has taken some steps intended to reduce this 

backlog, such as reducing the number of physicians needed for some 

panels. Nonetheless, a shortage of qualified physicians continues to 

constrain the agency’s capacity to decide cases more quickly. 

Consequently, claimants will likely continue to experience lengthy delays 

in receiving the determinations they need to file workers’ compensation 

claims. In the meantime, Energy has not kept claimants sufficiently 

informed about the delays in the processing of their claims as well as what 

claimants can expect as they proceed with state workers’ compensation 

claims. 

More than half of the cases associated with Energy facilities in the 9 states 

that account for more than three-quarters of all Subtitle D cases filed are 

likely to have a willing payer of benefits. Another quarter of the cases for 

these 9 states, while not technically having a willing payer, have workers’ 

compensation coverage provided by an insurer that has stated that it will 

not contest these claims. However, the remaining 20 percent of the cases 

in these 9 states lack willing payers and are likely to be contested, which 

means that many of these cases may be less likely to receive 

compensation. Because of data limitations, these percentages provide an 

order of magnitude estimate of the extent to which claims will have willing 

payers. The estimates are not a prediction of actual benefit outcomes for 

claimants. Further, these estimates could change as better data become 

available or as circumstances change, such as new contractors taking over 

at individual facilities. For example, the contract for environmental 

cleanup at a facility in Kentucky will expire on September 30, 2004, and it 

is unclear at this point how the subsequent contractor will deal with the 

claims of employees of prior contractors. If the change in contractors 

results in these claims being contested, our overall estimate of the cases 

that are likely to be contested could increase to 33 percent. For all 

claimants, actual compensation is not certain because of additional factors 

such as the rules in the state workers’ compensation programs or 

contractors’ uncertainty on how to compute the benefit. 

Various options are available to improve payment outcomes for the cases 

that receive a positive physician panel determination, but lack willing 

payers under the current program. If it were decided that the program 

should be modified, the options for changing it range from adding a federal 

benefit to the existing program for cases that lack a willing payer to 

designing a completely new program. Congress would need to examine 

these options in terms of several issues, including the source, method, and 
Page 4 GAO-04-516 Energy Employees Compensation 

amount of the federal funding required to pay benefits; the length of time 

needed to implement changes; the criteria for determining who is eligible; 

and the equitable treatment of claimants. In particular, the federal cost 

implications of these options should be carefully considered in the context 

of the current and projected federal fiscal environment. 

We are making several recommendations to Energy to help improve its 

effectiveness in assisting Subtitle D claimants in obtaining compensation 

for occupational illnesses. Specifically, we are recommending that Energy 

take additional steps to expedite the processing of claims through its 

physician panels, enhance the quality of its communications with 

claimants, improve the quality of its case management data and its 

capabilities to aggregate these data to address program issues, and 

consider developing a legislative proposal to address the willing payer 

issue. In commenting on a draft of this report, Energy indicated that the 

agency had already incorporated several of our recommendations and will 

aggressively tackle the remainder. However, Energy did not specifically 

comment on each recommendation. In addition, Energy highlighted 

initiatives either planned or underway that pertain to our 

recommendations. Energy’s comments are provided in appendix II. 

Energy oversees a nationwide network of 40 contractor-operated 

industrial sites and research laboratories that have historically employed 

more than 600,000 workers in the production and testing of nuclear 

weapons. In implementing EEOICPA, the President acknowledged that it 

had been Energy’s past policy to encourage and assist its contractors in 

opposing workers’ claims for state workers’ compensation benefits based 

on illnesses said to be caused by exposure to toxic substances at Energy 

facilities.1

 Under the new law, workers or their survivors could apply for 

assistance from Energy in pursuing state workers’ compensation benefits, 

and if they received a positive determination from Energy, the agency 

would direct its contractors to not contest the workers’ compensation 

claims or awards. Energy’s rules to implement the new program became 

effective in September 2002, and the agency began to process the 

applications it had been accepting since July 2001, when the law took 

effect. 

 1

Executive Order 13179, December 7, 2000. 

Background 
Page 5 GAO-04-516 Energy Employees Compensation 

Energy’s claims process has several steps. First, claimants file applications 

and provide all available medical evidence. Energy then develops the 

claims by requesting records of employment, medical treatment, and 

exposure to toxic substances from the Energy facilities at which the 

workers were employed. If Energy determines that the worker was not 

employed by one of its facilities or did not have an illness that could be 

caused by exposure to toxic substances, the agency finds the claimant 

ineligible. For all others, once development is complete, a panel of three 

physicians reviews the case and decides whether exposure to a toxic 

substance during employment at an Energy facility was at least as likely as 

not to have caused, contributed to, or aggravated the claimed medical 

condition. The panel physicians are appointed by the National Institute for 

Occupational Safety and Health (NIOSH) but paid by Energy for this work. 

Claimants receiving positive determinations are advised that they may 

wish to file claims for state workers’ compensation benefits. Claimants 

found ineligible or receiving negative determinations may appeal to 

Energy’s Office of Hearings and Appeals. 
Page 6 GAO-04-516 Energy Employees Compensation 

Figure 1: Energy’s Claims Process 

Each of the 50 states and the District of Columbia has its own workers’ 

compensation program to provide benefits to workers who are injured on 

the job or contract a work-related illness. Benefits include medical 

treatment and cash payments that partially replace lost wages. 

Collectively, these state programs paid more than $46 billion in cash and 

medical benefits in 2001. In general, employers finance workers’ 

compensation programs. Depending on state law, employers finance these 

programs through one of three methods: (1) they pay insurance premiums 

to a private insurance carrier, (2) they contribute to a state workers’ 

compensation fund, or (3) they set funds aside for this purpose as selfinsurance. Although state workers’ compensation laws were enacted in 

part as an attempt to avoid litigation over workplace accidents, the 

workers’ compensation process is still generally adversarial, with 

Claims sent 

by mail

Claims received from 10 

Resource Centers

Energy 

develops claims

Physician panel reviews 

case and recommends

positive or negative

determination

Negative

determination

Positive 

determination

Energy decides claim is 

ineligible based on

non-covered employment or

illness

Energy makes final

determination and

notifies applicant

Claimant may file for 

state workers'

compensation benefits

Claimant may appeal

 determination to Energy's 

 Office of Hearings and Appeals

Records retrieval at

Energy facilities

Source: GAO analysis of Energy Claims Process.
Page 7 GAO-04-516 Energy Employees Compensation 

employers and their insurers tending to contest aspects of claims that they 

consider not valid. 

State workers’ compensation programs vary as to the level of benefits, 

length of payments, and time limits for filing. For example, in 1999, the 

maximum weekly benefit for a total disability in New Mexico was less than 

$400, while in Iowa it was approximately $950. In addition, in Idaho, the 

weekly benefit for total disability would be reduced after 52 weeks, while 

in Iowa benefits would continue at the original rate for the duration of the 

disability. Further, in Tennessee, a claim must be filed within 1 year of the 

beginning of incapacity or death. In contrast, in Kentucky, a claim must be 

filed within 3 years of either the last exposure to most substances or the 

onset of disease symptoms, but within 20 years of exposure to radiation or 

asbestos. 

EEOICPA allows Energy, to the extent permitted by law, to direct its 

contractors to not contest the workers’ compensation claims filed by 

Subtitle D claimant who received a positive determination from a 

physician panel. In addition, the statute prohibits the inclusion of the costs 

of contesting such claims as allowable costs under its contracts with the 

contractors; however, Energy’s regulations allow the costs incurred as the 

result of a workers’ compensation award to be reimbursed in the manner 

permitted under the contracts. The Subtitle D program does not affect the 

normal operation of state workers’ compensation programs other than 

limiting the ability of Energy or its contractors to contest certain claims; 

Energy does not have authority to expand or contract the scope of any of 

these state programs. Thus, actions taken by Energy or its contractors will 

not make a worker eligible for compensation under a state workers’ 

compensation system if the worker is not otherwise eligible. 

As of December 31, 2003, Energy had completely processed about 

6 percent of the more than 23,000 cases that had been filed, and the 

majority of all cases filed were associated with facilities in 9 states. Energy 

had begun processing on nearly 35 percent of cases, but processing had 

not begun on nearly 60 percent of the cases. Assessment of Energy’s 

achievement of case processing goals is complicated by systems 

limitations. Further, these limitations make it difficult to assess the 

achievement of goals related to program objectives, such as the quality of 

the assistance given to claimants in filing for state workers’ compensation. 

Energy Has Processed 

Few Cases, and 

Insufficient Strategic 

Planning and Data 

Collection Complicate 

Program Management 
Page 8 GAO-04-516 Energy Employees Compensation 

During the first 21⁄2 years of the program, ending December 31 2003, 

Energy had fully processed about 6 percent of the more than 23,000 cases 

it received. The majority of these fully processed cases had been found 

ineligible because of either a lack of employment at an eligible facility or 

an illness related to toxic exposure. Of the cases that had been fully 

processed, 150 cases—less than 1 percent of the more than 23,000 cases 

filed—had received a final determination from a physician panel. More 

than half of these determinations (87 cases) were positive. As of the end of 

calendar year 2003, Energy had not yet begun processing nearly 60 percent 

of the cases, and an additional 35 percent of cases were in various stages 

of processing. As shown in figure 2, the majority of the cases being 

processed were in the case development stage, where Energy requests 

information from the facility at which the claimant was employed. About 

2 percent of the cases in process were ready for physician panel review, 

and an additional 3 percent were undergoing panel review. 

Figure 2: Case status as of December 31, 2003 

A majority of all cases were filed early during program implementation, 

but new cases continue to be filed. More than half of all cases were filed 

within the first year of the program, between July 2001 and June 2002. 

However, between July 2002 and December 31, 2003, Energy continued to 

receive an average of more than 500 cases per month. Energy officials 

report that they continue to receive approximately 100 new cases per 

week. 

About 6 Percent of Cases 

Have Been Fully Processed 

6%

59% 35%

Fully processed

In processing

Unprocessed

95% In case 

development

2% Ready for 

physican panel

review

3% Undergoing 

physican panel 

review

Source: GAO analysis of Energy data.
Page 9 GAO-04-516 Energy Employees Compensation 

While cases filed are associated with facilities in 43 states or territories, 

the majority of cases are associated with Energy facilities in 9 states, as 

shown in figure 3. Facilities in Colorado, Idaho, Iowa, Kentucky, 

New Mexico, Ohio, South Carolina, Tennessee, and Washington account 

for more than 75 percent of cases received by December 31, 2003. The 

largest group of cases is associated with facilities in Tennessee. 

Figure 3: Distribution of Cases by Employee’s Last Energy Facility Worked 

Note: Facility information is missing or unknown for 1,859 cases. 

Workers filed the majority of cases, and cancer is the most frequently 

reported illness. Workers filed more than 60 percent of cases, and 

survivors of deceased workers filed about 36 percent of cases. In 2 percent 

of the cases, a worker filed a claim that was subsequently taken up by a 

survivor. Cancer is the illness reported in nearly 60 percent of the cases. 

Energy Facilities in 9 

States Account for More 

than 75 percent of Cases 

Washington

1,851

Idaho

904

Colorado

1,685

New Mexico

1,601

Ohio

1,305

Kentucky

2,375

Tennessee

4,319

South Carolina

3,379

Iowa

675

Nine states with most cases (N = 18,094)

Other states and territories with cases (N = 3,133)

States and territories with no cases

Source: GAO analysis of Energy data.

Marshall Islands
Page 10 GAO-04-516 Energy Employees Compensation 

Diseases affecting the lungs accounted for an additional 15 percent of the 

cases. Specifically, chronic beryllium disease and/or beryllium sensitivity 

were reported in 7 percent of the cases, 8 percent reported asbestosis, and 

less than 1 percent claimed chronic silicosis. 

Insufficient strategic planning regarding system design, data collection, 

and tracking of outcomes has made it more difficult for Energy officials to 

manage some aspects of the program and for those with oversight 

responsibilities to determine whether Energy is meeting goals for 

processing claims. The data system Energy uses to aid in case 

management was developed by contractors without detailed specifications 

from Energy. Furthermore, the system was developed before Energy 

established its processing goals and did not collect sufficient information 

to track Energy’s progress in meeting these goals. While recent changes to 

the system have improved Energy’s ability to track certain information, 

these changes have resulted in some recent status data being not 

completely comparable with older status data. In addition, Energy will be 

unable to completely track the timeliness of its processing for 

approximately one-third of the cases that were being processed as of 

December 2003 because key data are not complete. For example, Energy 

established a goal of completing case development within 120 days of case 

assignment to a case manager. At least 70 percent of the cases for which 

case development was complete were missing dates corresponding to 

either the beginning or the end of the case development process—data 

that would allow Energy officials to compute the time elapsed during case 

development. 

Energy has not been sufficiently strategic in identifying and systematically 

collecting certain data that are useful for program management. For 

instance, Energy does not track the reasons why particular cases were 

found ineligible in a format that can be easily analyzed. Systematic 

tracking of the reasons for ineligibility would make it possible to quickly 

identify cases affected by policy changes. For example, when a facility in 

West Virginia was determined to be only a Department of Energy facility 

and not also an atomic weapons employer, it was necessary for Energy to 

identify which cases had been ruled ineligible because of employment at 

the West Virginia facility. While some ineligibility information may be 

stored in case narratives, this information is not available in a format that 

would allow the agency to quickly identify cases declared ineligible for 

similar reasons. Ascertaining the reason for ineligibility would at best 

require review of individual case narratives, and indeed, Energy officials 

report that it is sometimes necessary to refer back to application forms to 

Insufficient Strategic 

Planning and Data 

Collection Limit Energy’s 

Ability to Determine 

whether Program Goals 

Are Being Met 
Page 11 GAO-04-516 Energy Employees Compensation 

find the reasons. As a result, if additional changes are made that change 

eligibility criteria, Energy may have to expend considerable time and 

resources determining which cases are affected by the change in policy. 

In addition, because it did not adequately plan for the various uses of its 

data, Energy lacks some of the data needed to analyze how cases will fare 

when they enter the state workers’ compensation systems. Specifically, it 

is difficult for Energy to predict whether willing payers of workers’ 

compensation benefits will exist using case management system data 

because the information about the specific employer for whom the 

claimant worked is not collected in a format that can be systematically 

analyzed. In addition, basic demographic data such as the age of 

employees is not necessarily accurate due to insufficient edit controls—

for example, error checking that would prevent employees’ dates of birth 

from being entered if the date was in the future or recent past. Reliable age 

data would allow Energy to estimate the proportion of workers who are 

likely to have health insurance such as Medicare. 

Insufficient tracking of program outcomes hampers Energy’s ability to 

determine how well it is providing assistance to claimants in filing claims 

for state workers’ compensation benefits. Energy has not so far 

systematically tracked whether claimants subsequently file workers’ 

compensation claims or the decisions on these claims. However, agency 

officials recently indicated that they now plan to develop this capability. In 

addition, Energy does not systematically track whether claimants who 

receive positive physician panel determinations file workers’ 

compensation claims, nor whether claims that are filed are approved, or 

paid. Furthermore, unless Energy’s Office of Hearings and Appeals grants 

an appeal of a negative determination, which is returned to Energy for 

further processing, Energy does not track whether a claimant files an 

appeal. Lack of information about the number of appeals and their 

outcomes may limit Energy’s ability to assess the quality and consistency 

of its decision making. 
Page 12 GAO-04-516 Energy Employees Compensation 

Energy was slow in implementing its initial case processing operation, but 

it is now processing enough cases so that there is a backlog of cases 

awaiting physician panel review. With panels operating at full capacity, the 

small pool of physicians qualified to serve on the panels may ultimately 

limit the agency’s ability to produce more timely determinations. 

Claimants have experienced lengthy delays in receiving the determinations 

they need to file workers’ compensation claims and have received little 

information about claims status as well as what they can expect from this 

process. Energy has taken some steps intended to reduce the backlog of 

cases. 

Energy’s case development process has not always produced enough 

cases to ensure that the physician panels were functioning at full capacity, 

but the agency is now processing enough cases to produce a backlog of 

cases waiting for panel review. Energy officials established a goal of 

completing the development of 100 cases per week by August 2003 to keep 

the panels fully engaged. However, the agency did not achieve this goal 

until several months later. 

Energy was slow to implement its case development operation. Initially, 

agency officials did not have a plan to hire a specific number of employees 

for case development, but they expected to secure additional staff as they 

were needed. When Energy first began developing cases, in the fall of 

2002, the case development process had about 8 case managers. With 

modest staffing increases, the program quickly outgrew the office space 

used for this function. Though Energy officials acknowledged the need for 

more personnel by spring 2003, they delayed hiring until additional space 

could be secured in August. By November 2003, Energy had more than 

tripled the number of case managers developing cases, and since that 

month the agency has continued to process an average of more than 

100 cases per week to have them ready for physician panel review. 

A Shortage of 

Qualified Physicians 

to Issue 

Determinations 

Delays Filing of 

Workers’ 

Compensation 

Claims, and Claimants 

May Receive 

Inadequate 

Information to 

Prepare Them to 

Pursue These Claims 

Sufficient Cases Have Not 

Always Been Available for 

Physician Panel Review, 

but Energy Has Increased 

the Pace of Its Case 

Development Processing 
Page 13 GAO-04-516 Energy Employees Compensation 

Energy transferred nearly $10 million in fiscal year 2003 funds into this 

program from other Energy accounts. Further, after completing a 

comprehensive review of its Subtitle D program, the agency developed a 

plan that identifies strategies for further accelerating its case processing. 

This plan sets a goal of eliminating the entire case backlog by the end of 

calendar year 2006 and depends in part on shifting an additional 

$33 million into the program in fiscal year 2004, to quadruple the caseprocessing operation. With additional resources, Energy plans to complete 

the development of all pending cases as quickly as possible and have them 

ready for the physician panels. However, this could create a larger backlog 

of cases awaiting review by physician panels. Because a majority of the 

claims filed so far are from workers whose medical conditions are likely to 

change over time, building this backlog could further slow the decision 

process by making it necessary to update medical records before panel 

review. 

Even though additional resources have allowed Energy to speed initial 

case development, the limited pool of qualified physicians for panels may 

limit Energy’s capacity to decide cases more quickly. Under the rules 

Energy originally established for this program that required that each case 

be reviewed by a panel of 3 physicians and given the 130 physicians 

currently available, it could have taken more than 13 years to process all 

cases pending as of December 31, without consideration of the hundreds 

of new cases the agency is receiving each month.2

 However, in an effort to 

make the panel process more efficient, Energy published new rules on 

March 24, 2004, that re-defined a physician panel as one or more 

physicians appointed to evaluate these cases and changed the timeframes 

for completing their review. Under the new rule, a panel composed of a 

single physician will initially review each case, and if a positive 

determination is issued, no further review is necessary. Negative 

determinations made by a single physician panels will require review by 

one or more additional single-physician panels. In addition to revising its 

rules, the agency began holding a full-time physician panel in Washington, 

D.C., in January 2004, staffed by physicians who are willing to serve fulltime for a 2- or 3-week period. 

 2

This 13-year estimate assumes that none of the pending cases would be determined 

ineligible on the basis of noncovered employment or illnesses because we did not possess a 

sufficient basis for projecting the number of pending cases that would be determined 

ineligible in the future. 

The Ability to Produce 

More Timely Decisions 

May Be Limited by the 

Small Pool of Qualified 

Physicians and Gaps in 

Information They Need to 

Quickly Decide Cases 
Page 14 GAO-04-516 Energy Employees Compensation 

Energy and NIOSH officials have taken steps to expand the number of 

physicians who would qualify to serve on the panels and to recruit more 

physicians, including some willing to work full-time. While Energy has 

made several requests that NIOSH appoint additional physicians to staff 

the panels, such as requesting 500 physicians in June 2003, NIOSH officials 

have indicated that the pool of physicians with the appropriate credentials 

and experience is limited.3

 The criteria NIOSH originally used to evaluate 

qualifications for appointing physicians to these panels included: (1) board 

certification in a primary discipline; (2) knowledge of occupational 

medicine; (3) minimum of 5 years of relevant clinical practice following 

residency; and (4) reputation for good medical judgment, impartiality, and 

efficiency. NIOSH recently modified these qualifications, primarily to 

reduce the amount of required clinical experience so that physicians with 

experience in relevant clinical or public health practice or research, 

academic, consulting, or private sector work can now qualify to serve on 

the panels. NIOSH has revised its recruiting materials to reflect this 

change and to point out that Energy is also interested in physicians willing 

to serve on panels full-time. However, a NIOSH official said that he was 

uncertain about the effect of the change in qualifications on the number of 

available physicians. In addition, the official indicated that only a handful 

of physicians would likely be interested in serving full-time on the panels. 

Energy officials have also explored additional sources from which NIOSH 

might recruit qualified physicians, but they have expressed concerns that 

the current statutory cap on the rate of pay for panel physicians may limit 

the willingness of physicians from these sources to serve on the panels. 

For example, Energy officials have suggested that physicians in the 

military services might be used on a part-time basis, but the rate of pay for 

their military work exceeds the current cap. Similarly, physicians from the 

Public Health Service could serve on temporary full-time details as panel 

physicians. To elevate the rate of pay for panel physicians to a level that is 

consistent with the rate physicians from these sources normally receive, 

Energy officials recently submitted to the Congress a legislative proposal 

to eliminate the current cap on the rate of pay and also expand Energy’s 

hiring authority. 

 3

In March 2004, Energy requested additional physicians from NIOSH that would result in 

tripling the number of full-time equivalent physicians in 2004 and increasing the number of 

full-time equivalent physicians by a factor of 6 in 2005. 
Page 15 GAO-04-516 Energy Employees Compensation 

Panel physicians have also suggested methods to Energy for improving the 

efficiency of the panels. For example, some physicians have said that more 

complete profiles of the types and locations of specific toxic substances at 

each facility would speed their ability to decide cases. While Energy 

officials reported that they have completed facility overviews for most of 

the major sites, specific site reference data are available for only a few 

sites. Energy officials told us that, in their view, the available information 

is sufficient for decision making by the panels. However, based on 

feedback from the physicians, Energy officials are exploring whether 

developing additional site information would be cost beneficial. 

Energy has not always provided claimants with complete and timely 

information about what they could achieve in filing under this program. 

Energy officials concede that claimants who filed in the early days of the 

program may not have been provided enough information to understand 

the benefits they were filing for. As a consequence, some claimants who 

filed under both Subtitle B and Subtitle D early in the program later 

withdrew their claims under Subtitle D because they had intended to file 

only for Subtitle B benefits or because they had not understood that they 

would still have to file for state workers’ compensation benefits after 

receiving a positive determination from a physician panel. After the final 

regulations were published in August 2002, Energy officials said that 

claimants had a better understanding of the benefits for which they were 

applying. 

Energy has not kept claimants sufficiently informed about the status of 

their claims under Subtitle D. Until recently, Energy’s policy was to 

provide no written communication about claims status between the 

acknowledgment letters it sent shortly after receiving applications and the 

point at which it began to process claims. Since nearly half of the claims 

filed in the first year of the program remained unprocessed as of the 

December 31, 2003, these claimants would have received no information 

about the status of their claims for more than 1 year. Energy recently 

decided to change this policy and provide letters at 6-month intervals to all 

claimants with pending claims. Although the first of these standardized 

letters sent to claimants in October 2003 did not provide information about 

individual claims status, it did inform claimants about a new service on the 

program’s redesigned Web site through which claimants can check on the 

status of their claim. However, this new capability does not provide 

claimants with information about the timeframes during which their 

claims are likely to be processed and claimants would need to re-check 

Energy Has Not 

Sufficiently Informed 

Claimants about the Status 

of Their Claims and 

Subsequent Aspects of the 

Process 
Page 16 GAO-04-516 Energy Employees Compensation 

the status periodically to determine whether the status of the claim has 

changed. 

In addition, claimants may not receive sufficient information about what 

they are likely to encounter when they file for state workers’ 

compensation benefits. For example, Energy’s letter to claimants 

transmitting a positive determination from a physician panel does not 

always provide enough information about how they would go about filing 

for state workers’ compensation benefits. A contractor in Tennessee 

reported that a worker was directed by Energy’s letter received in 

September 2003 to file a claim with the state office in Nashville when 

Tennessee’s rules require that the claim be filed with the employer. The 

contractor reported the problem to Energy in the same month, but Energy 

letters sent to Tennessee claimants in October and December 2003 

continued to direct claimants to the state office. Finally, claimants are not 

informed as to whether there is likely to be a willing payer of workers’ 

compensation benefits and what this means for the processing of that 

claim. Specifically, advocates for claimants have indicated that claimants 

may be unprepared for the adversarial nature of the workers’ 

compensation process when an insurer or state fund contests the claim. 

Energy officials recently indicated that they plan to test initiatives to 

improve communication with claimants. Specifically, they plan to conduct 

a test at one Resource Center that would provide claimants with additional 

information about the workers’ compensation process and advice on how 

to proceed after receiving a positive physician panel determination. In 

addition, they plan to begin contacting individuals with pending claims this 

summer to provide information on the status of their claims. 

Our analysis shows that a majority of cases associated with Energy 

facilities in 9 states that account for more than three-quarters of all 

Subtitle D cases filed are not likely to be contested. However, the 

remaining 20 percent of cases lack willing payers and are likely to be 

contested. These percentages provide an order of magnitude estimate of 

the extent to which claimants will have willing payers and are not a 

prediction of actual benefit outcomes for claimants. 

While Workers’ 

Compensation Claims 

for a Majority of 

Cases Are Not Likely 

to Be Contested, 

Actual Compensation 

Is Not Certain 
Page 17 GAO-04-516 Energy Employees Compensation 

The workers’ compensation claims for the majority of cases associated 

with major Energy facilities in 9 states4

 are likely to have no challenges to 

their claims for state workers’ compensation benefits. Specifically, based 

on analysis of workers’ compensation programs and the different types of 

workers’ compensation coverage used by the major contractors, it appears 

that slightly more than half of the cases will potentially have a willing 

payer. In these cases, self-insured contractors will not contest the claims 

for benefits as ordered by Energy. Another 25 percent of the cases, while 

not technically having a willing payer, have workers’ compensation 

coverage provided by an insurer that has stated that it will not contest 

these claims and is currently processing several workers’ compensation 

claims without contesting them. The remaining 20 percent of cases in the 9 

states we analyzed are likely to be contested. Because of data limitations, 

these percentages provide an order of magnitude estimate of the extent to 

which claimants will have willing payers.5

 The estimates are not a 

prediction of actual benefit outcomes for claimants. 

As shown in table 1, the contractors for four major facilities in these states 

are self-insured, and Energy’s direction to them to not contest claims that 

receive a positive physician panel determination will be adhered to. In 

such situations where there is a willing payer, the contractor’s action to 

pay the compensation consistent with Energy’s order to not contest a 

claim could result in a payment that might otherwise have resulted in a 

denial of a claim, for reasons such as failure to file a claim within a 

specified period of time. Similarly, the informal agreement by the 

commercial insurer with the contractors at the two facilities that 

constitute 25 percent of the cases to pay the workers compensation claims 

will more likely result in payment, despite potential grounds to contest 

 4

The cases in these 9 states represent more than three-quarters of the cases filed 

nationwide. The results of our analysis cannot necessarily be applied to the remaining 

25 percent of the cases filed nationwide. 

5

Because of data limitations, we assumed that: (1) all cases filed would receive a positive 

determination by a physician panel; (2) all workers lost wages because of the illness and 

were not previously compensated for this loss; and (3) in all cases, the primary contractor 

rather than a subcontractor at the Energy facility employed the worker. While we believe 

that the first two assumptions would not affect the proportions shown in each category, the 

third assumption could result in an underestimate of the proportion of cases lacking willing 

payers to the extent that some workers may have been employed by subcontractors that 

used commercial insurers or state funds for workers’ compensation coverage. Some 

subcontractors use these methods of workers’ compensation coverage because they may 

not employ enough workers to qualify for self-insurance under some state workers’ 

compensation programs. 

A Majority of Cases in 9 

States Are Not Likely to Be 

Contested 
Page 18 GAO-04-516 Energy Employees Compensation 

under state law. However, since this insurer is not bound by Energy’s 

orders and it does not have a formal agreement with either Energy or the 

contractors to not contest these claims, there is nothing to guarantee that 

the insurer will continue to process claims in this manner. 

About 20 percent of cases in the 9 states we analyzed are likely to be 

contested. Therefore, in some instances, these cases may be less likely to 

receive compensation than a comparable case for which there is a willing 

payer, unless the claimant is able to overcome challenges to the claim. In 

addition, contested cases can take longer to be resolved. For example, one 

claimant whose claim is being contested by an insurer was told by her 

attorney that because of pretrial motions filed by the opposing attorney, it 

would be 2 years before her case was heard on its merits. Specifically, the 

cases that lack willing payers involve contractors that (1) have a 

commercial insurance policy, (2) use a state fund to pay workers’ 

compensation claims, or (3) do not have a current contract with Energy. In 

each of these situations, Energy maintains that its orders to contractors 

would have a limited effect. For instance, an Ohio Bureau of Workers’ 

Compensation official said that the state would not automatically approve 

a case with a positive physician panel determination, but would evaluate 

each workers’ compensation case carefully to ensure that it was valid and 

thereby protect its state fund. Furthermore, although the contractor in 

Colorado with a commercial policy attempted to enter into agreements 

with prior contractors and their insurers to not contest claims, the parties 

have not yet agreed and several workers’ compensation claims filed with 

the state program are currently being contested. 
Page 19 GAO-04-516 Energy Employees Compensation 

Table 1: Extent to Which Cases Will Potentially Be Contested in 9 States 

Likely 

outcome 

Willing 

payer 

available? 

Types of Workers Comp. 

coverage Energy facility, state 

Number of 

cases as 

reported 

in Energy 

data 

Percentage 

of cases in 

category

Contests are not likely

 Yes Self-insurance Paducah Gaseous Diffusion Plant, Kentuckya 2,133

 Los Alamos National Lab, New Mexico 1,380

 Oak Ridge K-25, X-10, and Y-12 Plants, 

Tennessee 

4,115

 Hanford Site, Washington 1,798

 Subtotal 9,426 55 %

 Nob Commercial policy, insurer 

will follow contractors’ 

instructions to not contest 

Idaho National Engineering Lab, Idaho 849

 Savannah River Site, South Carolina 3,375

 Subtotal 4,224 25 %

Subtotal 13,650 80 %

Contests likely 

 No Commercial policy Rocky Flats Plant, Colorado 1,630

 No State fund Portsmouth Gaseous Diffusion Plant, Ohio 862

 Feed Materials Production Center, Ohio 286

 Mound Plant, Ohio 91

 No No current contractor Iowa Ordnance Plant, Iowa 645

Subtotal 3,514 20% 

Source: GAO analysis of Energy data and interviews with current contractors and state officials. 

Note: The table includes the cases from the facilities in these states with the largest number of cases 

filed but does not include the remaining 693 cases (4 percent) from other facilities in these states. 

a

A total of 2,370 cases have been filed for the Paducah Gaseous Diffusion Plant, which has been 

operated since July 1998 by a private entity that leases the facility. Energy recently decided that 

workers who have only been employed by this private entity, and not by the prior contractors who 

operated the facility, will not be eligible for the program. An Energy contractor performing 

environmental cleanup at the site also employs workers at the facility. This contractor is responsible 

for the workers’ compensation claims filed by its employees as well as those filed by employees of 

the contractors who operated the facility prior to July 1998. We apportioned 90 percent of the cases 

filed for the Paducah facility (2,133) to the cleanup contractor because the facility was run by the prior 

contractors for about 90 percent of its years in operation. We apportioned the remaining 10 percent of 

the cases (237) to the private entity and do not show these cases in the table, due to Energy’s 

decision that claims filed by the entity’s workers would be ineligible for the program. However, this 

apportionment involves some uncertainty because the clean up contractor has not had an opportunity 

to analyze the effects of Energy’s policy decision. 
Page 20 GAO-04-516 Energy Employees Compensation 

b

This insurer is technically not a willing payer since it is not bound by Energy’s orders and it does not 

have a formal agreement with either Energy or the contractors to not contest these claims for 

workers’ compensation. However, the insurer has stated that it will follow contractors’ instructions to 

not contest these claims. 

These estimates could change as better data become available or as 

circumstances change, such as new contractors taking over at individual 

facilities. For example, the contractor currently performing environmental 

cleanup at the Paducah Gaseous Diffusion Plant will not re-compete for 

this work when its contract ends on September 30, 2004. Energy is 

soliciting proposals for a new contract to continue the cleanup work and 

has indicated that the new contractors will not be required to take on the 

responsibility for the workers’ compensation claims filed by employees of 

former contractors. While Energy has proposed that the current clean up 

contractor continue to handle the claims of their employees and those of 

prior contractors under another of its contracts with the agency, it is 

unclear at this point whether the current contractor will be able to arrange 

for continuing coverage of these claims without securing workers’ 

compensation coverage through commercial insurance. Unless the current 

contractor can continue to self-insure its workers’ compensation coverage 

for these claims, the Paducah cases shown in table 1 would have to be 

moved to the category in which contests are likely. As a result of this 

single change in contractors, the proportion of cases for which contests 

are likely could increase from 20 to 33 percent. 

In contrast to Subtitle B provisions that provide for a uniform federal 

benefit that is not affected by the degree of disability, various factors may 

affect whether a Subtitle D claimant is paid under the state workers’ 

compensation program or how much compensation will be paid. Beyond 

the differences in the state programs that may result in varying amounts 

and length of payments, these factors include the demonstration of a loss 

resulting from the illness and contractors’ uncertainty on how to compute 

compensation. 

Even with a positive determination from a physician panel and a willing 

payer, claimants who cannot demonstrate a loss, such as loss of wages or 

unreimbursed medical expenses, may not qualify for compensation. On the 

other hand, claimants with positive determinations but not a willing payer 

may still qualify for compensation under the state program if they show a 

loss and can overcome all challenges to the claim raised by the employer 

or the insurer. 

Multiple Factors Make 

Compensation Not Certain 
Page 21 GAO-04-516 Energy Employees Compensation 

Contractors’ uncertainty about how to compute compensation may also 

cause variation in whether or how much a claimant will receive in 

compensation. While contractors with self-insurance told us that they plan 

to comply with Energy’s directives to not contest cases with positive 

determinations, some contractors were unclear about how to actually 

determine the amount of compensation that a claimant will receive. For 

example, one contractor raised a concern that no guidance exists to 

inform contractors about whether they can negotiate the degree of 

disability, a factor that could affect the amount of the workers’ 

compensation benefit. Other contractors will likely experience similar 

situations, as Energy has not issued written guidance on how to 

consistently compute compensation amounts. 

While not directly affecting compensation amounts, a related issue 

involves how contractors will be reimbursed for claims they pay. Energy 

uses several different types of contracts to carry out its mission, such as 

operations or cleanup, and these different types of contracts affect how 

workers’ compensation claims will be paid. For example, a contractor 

responsible for managing and operating an Energy facility was told to pay 

the workers’ compensation claims from its current operating budget. The 

contractor said that this procedure may compromise its ability to conduct 

its primary responsibilities. On the other hand, a contractor cleaning up an 

Energy facility under a cost reimbursement contract was told by Energy 

officials that its workers’ compensation claims would be reimbursed and, 

therefore, paying claims would not affect its ability to perform cleanup of 

the site. 

Various options are available to improve payment outcomes for the cases 

that receive a positive determination from Energy, but lack willing payers 

under the current program. If it chooses to change the current program, 

Congress would need to examine these options in terms of several issues, 

including the source, method, and amount of the federal funding required 

to pay benefits; the length of time needed to implement changes; the 

criteria for determining who is eligible; and the equitable treatment of 

claimants. In particular, the cost implications of these options for the 

federal government should be carefully considered in the context of the 

current and projected federal fiscal environment. 

We identified four possible options for improving the likelihood of willing 

payers, some of which have been offered in proposed legislation. While 

not exhaustive, the options range from adding a federal benefit to the 

Several Issues Could 

Be Considered in 

Evaluating Options 

for Improving the 

Likelihood of Willing 

Payers 

Options for Changing the 

Current Program 
Page 22 GAO-04-516 Energy Employees Compensation 

existing program for cases that lack a willing payer to addressing the 

willing payer issue as part of designing a new program that would allow 

policymakers to decide issues such as the eligibility criteria and the type 

and amount of benefits without being encumbered by existing program 

structures. A key difference among the options is the type of benefit that 

would be provided. 

Option 1—State workers’ compensation with federal back up. This 

option would retain state workers’ compensation structure as under the 

current Subtitle D program but add a federal benefit for cases that receive 

a positive physician panel determination but lack a willing payer of state 

workers’ compensation benefits. For example, claims involving employees 

of current contractors that self-insure for workers’ compensation coverage 

would continue to be processed through the state programs. However, 

claims without willing payers such as those involving contractors that use 

commercial insurers or state funds likely to contest workers’ 

compensation claims could be paid a federal benefit that approximates the 

amount that would have been received under the relevant state program. 

Option 2—Federal workers’ compensation model. This option would 

move the administration of the Subtitle D benefit from the state programs 

entirely to the federal arena, but would retain the workers’ compensation 

concept for providing partial replacement of lost wages as well as medical 

benefits. For example, claims with positive physician panel determinations 

could be evaluated under the eligibility criteria of the Federal Employees 

Compensation Act6

 and, if found eligible, could be paid benefits consistent 

with the criteria of that program. 

Option 3—Expanded Subtitle B program that does not use a 

workers’ compensation model. Under this option, the current Subtitle B 

program would be expanded to include the other illnesses resulting from 

radiation and toxic exposures that are currently considered under the 

Subtitle D program. The Subtitle D program would be eliminated as a 

separate program and, if found eligible, claimants would receive a lumpsum payment and coverage of future medical expenses related to the 

workers’ illnesses, assuming they had not already received benefits under 

Subtitle B. The Department of Labor would need to expand its regulations 

 6

The Federal Employees’ Compensation Act (5 U.S.C. 8101, et seq.) provides workers’ 

compensation coverage for federal and postal employees, who are not covered by the state 

programs. 
Page 23 GAO-04-516 Energy Employees Compensation 

to specify which illnesses would be covered and the criteria for 

establishing eligibility for each of these illnesses. In addition, since the 

current programs have differing standards for determining whether the 

worker’s illness was related to his employment,7

 it would have to be 

decided which standard would be used for the new category of illnesses. 

Option 4—New federal program that uses a different type of 

benefit structure. This option would address the willing payer issue as 

part of developing a new program that involves moving away from the 

workers’ compensation and Subtitle B structures and establishing a new 

federal benefit administered by a structure that conforms to the type of the 

benefit and its eligibility criteria. This option would provide an opportunity 

to consider anew the purpose of the Subtitle D provisions. As a starting 

point, policymakers could consider different existing models such as the 

Radiation Exposure Compensation Act, designed to provide partial 

restitution to individuals whose health was put at risk because of their 

exposure even when their illnesses do not result in ongoing disability. But, 

they could also choose to build an entirely new program that is not based 

on any existing model. 

In deciding whether and how to change the Subtitle D program to ensure a 

source of benefit payments for claims that would be found eligible if they 

had a willing payer, policymakers will need to consider the trade-offs 

involved. Table 2 arrays the relevant issues to provide a framework for 

evaluating the range of options in a logical sequence. We have constructed 

the sequence of issues in this framework in terms of the purpose and type 

of benefit as being the focal point for the evaluation, with consideration of 

the other issues flowing from that first decision. For example, decisions 

about eligibility criteria would need to consider issues relating to withinstate and across-state equity for Subtitle D claimants. The framework 

would also provide for decisions on issues such as the method of federal 

funding—trust fund or increased appropriations—and the appropriate 

federal agency to administer the benefit. For each of the options, the type 

of benefit would suggest which agency should be chosen to administer the 

 7

Under Subtitle B, an individual with specified types of cancer shall be determined to have 

sustained that condition in the performance of duty if the cancer was at least as likely as 

not related to employment at a specified facility. Under Subtitle D, a physician panel must 

decide whether it is at least as likely as not that exposure to a toxic substance in the course 

of employment was a significant factor in aggravating, contributing to, or causing the 

illness or death of the worker. 

Various Issues Should Be 

Considered in Deciding 

Whether Changes Are 

Needed and Assessing the 

Options 
Page 24 GAO-04-516 Energy Employees Compensation 

benefit and would depend, in part, on an agency’s capacity to administer a 

benefit program. In examining these issues, the effects on federal costs 

would have to be carefully considered. Ultimately, policymakers will need 

to weigh the relative importance of these issues in deciding whether and 

how to proceed. 

In evaluating how the purpose and type of benefit now available under 

Subtitle D could be changed, policymakers would first need to focus on 

the goals they wish to achieve in providing compensation to this group of 

individuals. If the goal is to compensate only those individuals who can 

demonstrate lost wages because of their illnesses, a recurring cash benefit 

in an amount that relates to former earnings might be in order and a 

workers’ compensation option, either a state benefits with a federal back 

up or a federal workers’ compensation benefit, would promote this 

purpose. If, on the other hand, the goal is to compensate claimants for all 

cases in which workers were disabled because of their employment—even 

when workers continue to work and have not lost wages–the option to 

expand Subtitle B would allow a benefit such as a flat payment amount not 

tied to former earnings. 

For consideration of a new federal program option, it might be useful to 

also consider other federal programs dealing with the consequences of 

exposure to radiation as a starting point. For example, the Radiation 

Exposure Compensation Act was designed to provide partial restitution to 

individuals whose health was put at risk because of their exposure. Similar 

to Subtitle B, the act created a federal trust fund, which provides for 

payments to individuals who can establish that they have certain diseases 

and that they were exposed to radiation at certain locations and at 

specified times. However, this payment is not dependent on demonstrating 

ongoing disability or actual losses resulting from the disease. 

The options could also have different effects with respect to eligibility 

criteria and the equity of benefit outcomes for current Subtitle D claimants 

based on these criteria. By equity of outcomes, we mean that claimants 

with similar illnesses and circumstances receive similar benefit outcomes. 

The current program may not provide equity for all Subtitle D claimants 

within a state because a claim that has a willing payer could receive a 

different outcome than a similar claim that does not have a willing payer, 

but at least three of the options could provide within-state equity. With 

respect to across-state equity, the current program and the option to 

provide a federal back up to the state workers’ compensation programs 

Purpose and Type of 

Benefit 

Eligibility Criteria and 

Equity of Outcomes 
Page 25 GAO-04-516 Energy Employees Compensation 

would not achieve equity for Subtitle D claimants in different states. In 

contrast, the option based on a federal workers’ compensation model as 

well as the expanded Subtitle B option would be more successful in 

achieving across-state equity.8

Regardless of the option, changes made to Subtitle D could also 

potentially result in differing treatment of claims decided before and after 

the implementation of the change. In addition, changing the program to 

remove the assistance in filing workers’ compensation claims may be seen 

as depriving a claimant of an existing right. Further, any changes could 

also have implications beyond EEOICPA, to the extent that the changes to 

Subtitle D could establish precedents for federal compensation to private 

sector employees in other industries who were made ill by their 

employment. 

Effects on federal costs would depend on the generosity of the benefit in 

the option chosen and the procedures established for processing claims 

for benefits. Under the current program, workers’ compensation benefits 

that are paid without contest will come from contract dollars that 

ultimately come from federal sources—there is no specific federal 

appropriation for this purpose. Because all of the options are designed to 

improve the likelihood of payment for claimants who meet all other 

criteria, it is likely that federal costs would be higher for all options than 

under the current program. Specifically, federal costs would increase for 

the option to provide a federal back up to the state workers’ compensation 

program because it would ensure payment at rates similar to the state 

programs for the significant minority of claimants whose claims are likely 

to be contested and possibly denied under the state programs. Further, the 

federal costs of adopting a federal workers’ compensation option would 

be higher than under the first option because all claimants—those who 

would have been paid under the state programs as well as those whose 

claims would have been contested under the state programs—would be 

eligible for a federal benefit similar to the benefit for federal employees. In 

general, federal workers’ compensation benefits are more generous than 

state benefits because they replace a higher proportion of the worker’s 

salary than many states and the federal maximum rate of wage 

replacement is higher than all the state maximum rates. 

 8

An additional within-state equity issue involves the comparative treatment of Subtitle D 

claimants and all other workers’ compensation claimants in the same state. 

Federal Costs 
Page 26 GAO-04-516 Energy Employees Compensation 

For either of the two options mentioned earlier, a decision to offset the 

Subtitle D benefits against the Subtitle B benefit could lessen the effect of 

the increased costs, given reports by Energy officials that more than 

90 percent of Subtitle D claimants have also filed for Subtitle B benefits.9

However, the degree of this effect is difficult to determine because many 

of the claimants who have filed under both programs may be denied 

Subtitle B benefits. The key distinction would be whether workers who 

sustained certain types of illnesses based on their Energy employment 

should be compensated under both programs as opposed to recourse 

under only one or the other. If they were able to seek compensation from 

only one program, the claimant’s ability to elect one or the other based on 

individual needs should be considered. 

The effects on federal cost of an expanded Subtitle B option or a new 

federal program option are more difficult to assess. In many cases, the 

Subtitle B benefit of up to $150,000 could exceed the cost of the lifetime 

benefit for some claimants under either of the workers’ compensation 

options, resulting in higher federal costs. However, the extent of these 

higher costs could be mitigated by the fact that many of the claimants who 

would have filed for both benefits in the current system would be eligible 

for only one cash benefit regardless of the number or type of illnesses. The 

degree of cost or savings would be difficult to assess without additional 

information on the specific claims outcomes in the current Subtitle B 

program. The effects on federal costs for the new federal program option 

would depend on the type and generosity of the benefit selected. 

 9

Under the current Subtitle B and Subtitle D programs, benefits are not offset against each 

other. 
Page 27 GAO-04-516 Energy Employees Compensation 

Table 2: Framework for Evaluating Options to Change the Subtitle D Program 

 Current program 

Option 1—State 

workers’ 

compensation with 

federal back-up 

Option 2—Federal 

workers’ 

compensation model 

Option 3—

Expanded Subtitle 

B program 

Option 4—New 

federal benefit 

Purpose and 

type of benefit 

Varies by state, but 

generally includes 

medical treatment 

and cash payments 

that partially replace 

lost wages. 

Same as under 

current state 

programs. 

Still a workers’ 

compensation benefit, 

generally includes 

medical treatment and 

cash payments that 

partially replace lost 

wages. 

Same as for current 

Subtitle B—

coverage of future 

medical treatment 

and a one-time 

payment of up to 

$150,000 as 

compensation for 

disability or death 

because of 

exposure to 

radiation or toxic 

substance. 

Open for 

consideration. 

Eligibility 

criteria 

Vary by state, but 

generally apply to 

workers who contract 

a work-related illness 

and who lose work 

time because of the 

illness. 

For federal back-up 

benefit, should be 

similar to criteria 

under current state 

programs. 

Uses criteria of workers’ 

compensation program 

for federal employees. 

Same as for current 

Subtitle B claimants 

who worked for 

Energy contractors. 

Open for 

consideration—

should flow from 

type of benefit and 

the nature of the 

population it is 

designed to 

compensate. 

Interaction with 

Subtitle B 

Benefits are not offset 

against each other. 

Open for 

consideration. 

Open for consideration. No interaction 

issues. Claimants 

would be eligible for 

only one payment 

regardless of 

number of illnesses. 

Because there is a 

large overlap in 

claimants filing 

under both 

programs, this 

could potentially 

reduce the total 

number of claims 

that would remain 

to be processed 

once combined. 

Open for 

consideration. 

Depends on the 

nature of the 

benefit. 
Page 28 GAO-04-516 Energy Employees Compensation 

 Current program 

Option 1—State 

workers’ 

compensation with 

federal back-up 

Option 2—Federal 

workers’ 

compensation model 

Option 3—

Expanded Subtitle 

B program 

Option 4—New 

federal benefit 

Equity of 

outcomes 

within Subtitle 

D 

 

 Within states Similar cases in the 

same state could 

receive differing 

benefits depending on 

willing payer. 

Similar cases in the 

same state could 

receive similar 

benefits regardless of 

employer. 

Similar cases in the 

same state could 

receive similar benefits 

regardless of employer. 

Similar cases in the 

same state could 

receive similar 

benefits regardless 

of employer. 

Open for 

consideration. 

 Across states Similar cases in 

different states could 

receive differing 

compensation. 

Similar cases in 

different states could 

receive differing 

compensation. 

Similar cases in different 

states could receive 

similar compensation. 

Similar cases in 

different states 

could receive 

similar 

compensation 

Open for 

consideration. 

Funding 

source for 

benefits 

Most eligible cases 

with willing payers will 

be paid by contractors 

from contract funds 

from federal sources. 

Same as current 

program for cases 

with willing payer, but 

would need a source 

for federal back-up 

benefit. 

Would need new federal 

source. 

Trust fund already 

established by 

Section 3612 of 

EEOICPA. 

Open for 

consideration—

appropriations or 

trust fund. 

Federal 

administrator 

Energy. For federal benefit, 

selection criteria 

should include how 

quickly agency could 

implement and how 

well it was situated to 

process and pay 

cases. Energy would 

still need to secure 

records for all cases 

and process claims 

with willing payers. 

Department of 

Labor/Office of Workers’ 

Compensation 

administers current 

program; also 

administers Subtitle B 

program. Energy would 

still need to secure 

records. 

Department of 

Labor—same as 

current Subtitle B 

program. 

Open for 

consideration—

depends on type of 

benefit, experience 

in administering 

benefit program, 

and funding source.

Timeframe for 

implementation 

Program is 

implemented, but few 

cases have been 

completely 

processed. 

Relatively short to 

implement since it is 

based on existing 

program. 

Infrastructure would 

have to be established 

and rules developed 

to provide for federal 

benefits that mirror 

those of the state 

programs. 

Longer than Option 1. 

Infrastructure in place, 

but regulations for 

existing federal workers’ 

compensation program 

would need to be 

expanded to cover new 

benefit. 

Longer than Option 

1– structure in 

place to administer 

existing Subtitle B 

program—new 

rules need to be 

developed for 

evaluating 

additional illnesses. 

Potentially longest 

of all options. 

Depends on 

administrator and 

whether 

infrastructure exists 

or would need to be 

built. In either 

event, need to 

publish rules and 

establish 

procedures. 
Page 29 GAO-04-516 Energy Employees Compensation 

 Current program 

Option 1—State 

workers’ 

compensation with 

federal back-up 

Option 2—Federal 

workers’ 

compensation model 

Option 3—

Expanded Subtitle 

B program 

Option 4—New 

federal benefit 

Federal cost For cases that are not 

contested, benefits 

that are paid will 

ultimately come from 

contract dollars from 

federal sources. 

Federal costs could 

increase since 

benefits for cases 

without willing payers 

would be paid directly 

from federal funds. 

Federal costs could be 

greater than for current 

program since benefits 

would be based on the 

often more generous 

workers’ compensation 

program for federal 

workers. 

To the extent that 

the option would 

ensure a source of 

benefits, could 

increase federal 

costs. However, the 

extent of these 

higher costs could 

be mitigated 

because many of 

the claimants who 

would have filed for 

Subtitle B and D 

benefits in the 

current system 

would be eligible for 

only one cash 

benefit. 

Open for 

consideration—

Depends on type of 

benefit and 

eligibility criteria. 

Source: GAO analysis. 

More than 3 years after the passage of EEOICPA, few claimants have 

received state workers’ compensation benefits as a result of assistance 

provided by Energy. While Energy has eliminated the bottleneck in its 

claims process that it encountered early in program implementation—the 

initial development of cases—in doing so it has created a growing backlog 

of cases awaiting review by a physician panel. In the absence of changes 

that would expedite this review, many claimants will likely wait years to 

receive the determination they need to pursue a state workers’ 

compensation claim. In the interim, their medical conditions may worsen, 

and claimants may even die before they receive consideration by a state 

program. While Energy has taken some steps designed to reduce the 

backlog of cases for the physician panels, it is too early to assess whether 

these initiatives will be sufficient to resolve this growing backlog. 

Whether they ultimately receive positive or negative determinations, 

claimants deserve complete and timely information about what they could 

achieve in filing under this program, what the claims process entails, the 

status of their claims, and what they are likely to encounter when they file 

for state workers’ compensation benefits. Without complete information, 

claimants are unable to weigh the benefits and risks of pursuing the 

process to its conclusion. Indeed, given that the majority of claimants have 

also filed for benefits under Subtitle B and many may have already 

received decisions on those claims, some claimants may not be aware that 

Conclusions 
Page 30 GAO-04-516 Energy Employees Compensation 

they still have a Subtitle D claim pending. Further, given the limited 

communication from Energy since their claims were filed, some claimants 

may be unaware that resources are being expended developing their 

claims. Finally, because Energy does not currently communicate to 

claimants what they are likely to encounter when they file for state 

benefits, claimants may be unprepared for what may be a difficult and 

protracted pursuit of state benefits. 

Energy may be hindered in its ability to improve its claims process and 

evaluate the quality of the assistance it is providing to claimants in this 

program using the data it currently collects. Energy may also be 

unprepared to provide the analysis needed to inform policymakers as they 

consider whether changes to the program are needed because it does not 

systematically track the outcomes of cases that are appealed or the 

outcomes of claims that are filed with state workers’ compensation 

programs. Finally, Energy will be limited in its ability to provide complete 

and accurate information to claimants regarding the status and outcomes 

of their claims without good data. 

Even if all claimants were to receive timely physician panel determinations 

stating that the workers’ illnesses had likely been caused by their 

employment with Energy, some may never receive state workers’ 

compensation benefits. The lack of a willing payer may delay the receipt of 

benefits for some claimants as insurers and state fund officials challenge 

various aspects of the claim. For other claimants, the challenges raised in 

the absence of willing payers may ultimately result in denial of benefits 

based on issues such as not filing the claim within the time limits set by 

the state program—issues that would not be contested by willing payers. 

This disparity in potential outcomes for Subtitle D claimants may warrant 

the consideration of changes to the current program to ensure that eligible 

claims are paid without undue delay and that there is a willing payer for all 

claimants who would otherwise be eligible. 

To improve Energy’s effectiveness in assisting Subtitle D claimants in 

obtaining compensation for occupational illnesses, we recommend that 

the Secretary of Energy: 

• in order to reduce the backlog of cases waiting for review by a physician 

panel, take additional steps to expedite the processing of claims though its 

physician panels and focus its efforts on initiatives designed to allow the 

panels to function more efficiently. For example, Energy should pursue 

the completion of site reference data to provide physicians with more 

Recommendations for 

Executive Action 
Page 31 GAO-04-516 Energy Employees Compensation 

complete information about the type and degree of toxic exposures that 

may have occurred at each Energy facility. 

• in order to provide claimants with more complete information, expand and 

expedite its plans to enhance communications with claimants. These plans 

should focus on providing more complete information describing the 

assistance Energy will provide to claimants, the timeframes for claims 

processing, the status of claims, and the process that claimants will 

encounter when they file claims for state workers’ compensation benefits. 

• in order to facilitate program management and oversight, develop costeffective methods for improving the quality of the data in its case 

management system and increasing its capabilities to aggregate these data 

to address program issues. In addition, Energy should develop and 

implement plans to track the outcomes of cases that progress through the 

state workers’ compensation systems and use this information to evaluate 

the quality of the assistance it provides to claimants in the Subtitle D 

program. Such data could also be used by policy makers to assess the 

extent to which this program is achieving its goals and purposes. 

• in order to reduce disparities in potential outcomes between claimants 

with and without willing payers, consider developing a legislative proposal 

for modifying the EEOICPA statute to address the willing payer issue. 

When assessing different options, several issues such as those discussed in 

this report should be considered, including the purpose and type of 

benefit, eligibility criteria and equity of benefit outcomes, and effects on 

federal costs. 

We provided a draft of this report to Energy for comment. In commenting 

on the draft report, Energy indicated that the agency had already 

incorporated several of our recommendations and will aggressively tackle 

the remainder. However, Energy did not specifically comment on each 

recommendation. In addition, the comments highlighted several initiatives 

either planned or underway that are designed to improve the Subtitle D 

program. Several of these initiatives address issues raised in our report for 

which we recommended changes. In particular, Energy agreed with our 

findings regarding problems with communications with Subtitle D 

claimants and outlined the steps the agency has planned to correct these 

problems. Further, Energy agreed with our finding that there was not a 

system in place to track the outcomes of workers’ compensation claims 

filed with the state programs and indicated that the agency has recently 

initiated such a system, as we recommended. Finally, the comments 

provide more recent information about the agency’s progress in 

processing Subtitle D claims and reiterate the agency’s plan for eliminating 

Agency Comments 

and Our Evaluation 
Page 32 GAO-04-516 Energy Employees Compensation 

the backlog of claims by 2006. Energy’s comments are provided in 

appendix II. Energy also provided technical comments, which we have 

incorporated as appropriate. 

Copies of this report are being sent to the Secretary of Energy, appropriate 

congressional committees, and other interested parties. The report will 

also be made available at no charge on GAO’s Web site at 

http://www.gao.gov. If you have any questions about this report, please 

contact me at (202) 512-7215. Other contacts and staff acknowledgments 

are listed in appendix III. 

Sincerely yours, 

Robert E. Robertson 

Director, Education, Workforce, 

 and Income Security Issues 
Appendix I: Scope and Methodology 

Page 33 GAO-04-516 Energy Employees Compensation 

To determine the number of cases filed under Subtitle D, the status of 

these cases and characteristics of claimants, we used administrative data 

from Energy’s Case Management System (CMS). Energy does not publish 

standardized data extracts from this system, so we requested that Energy 

query the system to provide customized extracts for our analysis. The first 

extract contained data on the status and characteristics of cases filed 

between July 2001 and June 30, 2003. The second extract was obtained as 

an update and contained data related to cases filed between July 2001 and 

December 31, 2003. 

Because multiple claims can be associated with a single case, Energy’s 

system contains data at two levels — the case level and the claim level. 

For example, if both the widow and child of a deceased Energy employee 

file claims, both claims will be associated with a single case, which is 

linked to the Energy employee. At the case level, the system contains 

information about the Energy employee, such as date of birth and date of 

death (if applicable), the facilities at which the employee worked, and 

their dates of employment and the status of the case as it moves through 

the development process in preparation for physician panel review. At the 

claim level, CMS contains information related to the individual claimants, 

such as the date the claim was signed and the claimant’s relationship to 

the Energy employee. 

The extracts provided by Energy contain case-level data, for the most part. 

Data elements that are collected at the claim level were reported at the 

case level in our files. For example, the system includes a claim signature 

date for each claim. In our case-level file, Energy provided the earliest 

signature date, so that we would know when the first claim was signed. 

Illness data are also collected at the claim level. In our case-level file, 

Energy provided all the illnesses claimed by all claimants. We then 

aggregated the illness data to determine which illnesses were claimed on 

each case. 

We interviewed key Energy officials and contractors and reviewed 

available system documentation, such as design specifications and system 

update documents. Once the first data extract was received from Energy, 

we tested the data set to determine that it was sufficiently reliable for our 

purposes. Specifically, we performed electronic testing to identify missing 

data or logical inconsistencies and reviewed determination letters for 

cases that had physician panel determinations. We then computed 

descriptive statistics, including frequencies and cross-tabulations, to 

determine the number and status of cases received as of June 30, 2003. 

Appendix I: Scope and Methodology 
Appendix I: Scope and Methodology 

Page 34 GAO-04-516 Energy Employees Compensation 

When we received the second data extract, containing data through the 

end of calendar year 2003, we matched it to the first one to determine how 

many additional cases had been received between July 1, 2003, and 

December 31, 2003, and to determine if any cases were missing. We 

determined that some cases (less than 2 percent) that had been in the first 

extract were missing from the second file. We consulted with Energy 

contractors and determined that one case had been accidentally omitted 

from the query results and that the remaining cases had been dropped 

from CMS because they were duplicate cases or had been determined to 

be non-Subtitle D cases. This is possible because the Resource Centers use 

the CMS system to document incoming cases for both Subtitle B and 

Subtitle D. Energy contractors provided a replacement file that included 

the case that had been inadvertently dropped. They also reported that 

there were still a small number of duplicate cases identified in CMS, and 

hence in our data extract, but that Energy had not yet decided which cases 

to retain. Since Energy officials had not yet decided which case records to 

retain and which to delete at the time of our extract, we decided to leave 

the cases identified as duplicates in our analysis file. 

We reviewed available system documentation, performed electronic 

testing and reviewed determination letters for cases that had physician 

panel determinations to determine that the data contained in the second 

extract was sufficiently reliable for our purposes. During our electronic 

testing, we discovered a discrepancy between the December 31, 2003, 

status information included in our file and the December 31, 2003, status 

information reported by Energy on its Web site. On further discussion with 

Energy officials and contractors, we determined that when running the 

query, Energy contractors had calculated the December 31, 2003, status 

information using the wrong field in the database. Energy contractors gave 

us a third data file containing the correct status information that we then 

appended to the analysis file. We then computed additional descriptive 

statistics, including frequencies and cross-tabulations to determine the 

number and status of cases received as of December 31, 2003. 

To determine the extent to which Energy policies and procedures help 

employees file timely claims for state workers’ compensation benefits, we 

reviewed Energy’s regulations, policies, procedures, and communications 

with claimants. In addition, we interviewed key Energy officials and 

contractors at Energy facilities. We also interviewed panel physicians and 

contractors responsible for case development. In addition, we interviewed 

advocates, claimants, and officials at the National Institute for 

Occupational Safety and Health. Finally, we conducted site visits to three 
Appendix I: Scope and Methodology 

Page 35 GAO-04-516 Energy Employees Compensation 

Energy facilities in Oak Ridge, Tennessee—the state accounting for the 

largest number of Subtitle D cases. 

To estimate the number of claims for which there will not be willing 

payers of workers’ compensation benefits, we reviewed the provisions of 

workers’ compensation programs in the 9 states that account for more 

than three-quarters of the cases filed. The 9 states are: Colorado, Idaho, 

Iowa, Kentucky, New Mexico, Ohio, South Carolina, Tennessee, and 

Washington. The results of our analysis cannot necessarily be applied to 

the remaining 25 percent of the cases filed nationwide. Because of data 

limitations, we assumed that: (1) all cases filed would receive a positive 

determination by a physician panel; (2) all workers lost wages because of 

the illness and were not previously compensated for this loss; and (3) in all 

cases, the primary contractor rather than a subcontractor at the Energy 

facility employed the worker. While we believe that the first two 

assumptions would not affect the proportions shown in each category, the 

third assumption could result in an underestimate of the proportion of 

cases lacking willing payers to the extent that some workers may have 

been employed by subcontractors that used commercial insurers or state 

funds for workers’ compensation coverage. Some subcontractors use 

these methods of workers’ compensation coverage because they may not 

employ enough workers to qualify for self-insurance under some state 

workers’ compensation programs. We also interviewed Energy officials, 

key state workers’ compensation program officials, workers’ 

compensation experts, private insurers, and the contractors operating the 

major facilities in each of the states to determine the method of workers’ 

compensation coverage these facilities used. 

Finally, we took several steps to identify possible options for changing the 

program in the event that there may not be willing payers of benefits. We 

reviewed existing laws, regulations, and programs; analyzed pending 

legislation; and considered characteristics of existing federal and state 

workers’ compensation programs. We also identified the issues that would 

be relevant for policy makers to consider in implementing these options. 
Appendix II: Comments from the Department 

of Energy 

Page 36 GAO-04-516 Energy Employees Compensation 

Appendix II: Comments from the Department 

of Energy 
Appendix II: Comments from the Department 

of Energy 

Page 37 GAO-04-516 Energy Employees Compensation 
Appendix II: Comments from the Department 

of Energy 

Page 38 GAO-04-516 Energy Employees Compensation 
Appendix III: GAO Contacts and Staff 

Acknowledgments 

Page 39 GAO-04-516 Energy Employees Compensation 

Andrew Sherrill (202) 512-7252 

Beverly Crawford (202) 512-4474 

In addition to the above contacts, Melinda L. Cordero, Mary Nugent, and 

Rosemary Torres Lerma made significant contributions to this report. 

Also, Luann Moy and Elsie Picyk assisted in the study design and analysis; 

Margaret Armen provided legal support; and Amy E. Buck assisted with 

the message and report development. 

Appendix III: GAO Contacts and Staff 

Acknowledgments 

GAO Contacts 

Staff 

Acknowledgments 

(130364) 
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